HomeMy WebLinkAboutCover Page of Failed Inspection Report with Notes' _ ���� �� ,�� _
f
� � M� �� �`��a,�
� P RECEIVED C f,.
, � �� Commonweafth of Mlatssachusetts ,���L.—. !Z `� �
a
� Titte 5 C9ffi�fal ������#a�� ���r� �```'�� �'� '�,fi ,.
i Subsartace Seva�ge Dtsposaf S�:s6em F��n-Hk�+:�oc tio!ti�citanr,4ss�ss�erits NEAL7H DEPT.
� / �,/iw�(7/e C`�o� ,v.r r�-t,` '
Propeity Addross . /
Gt✓_t�G w ar bo Z �
ar nx Ow ner's Neme / —/ �"`
�f�`,,,�, W2s - a/✓rro� /'�/� !��-6 93 /o a o / �
A� �blTawn St�►ta Zfp tbtle DeRe M�s
Inspection results must be wbmitbed on fhls Uorm.Inspectlon fortns may not be altierod in any
way. Pleaae�ee compistisne�cheddiatattha end otthe form.
�,r,`�" A. General lnformation
���,
'�°°nh'"'e'ab 'i. I�spector. �
ksy to rnovs yar / / /�
a�w-do n« c�,r h' �"o��!'e�1!i
use tl�e�n Nacro of r►spec�or
�' . ��f/r�i o !EG-h�
� ��� �O �o�(. ��.��
� ��nY A �----- �i `
� � G S I �rN'/ � Do�b�o�
t�ily/Tavn� � oZ��_" //�� � �D�O� ��
J�
Te�eptrons ucense N�
B. Cert�fiCation
i certify tt�at i hev�e persanaliy inspected the sewage�sposal system at this address and tt�t tha
informatfon reported b�aw is true, accu�de and complete as ofthe time ofthe ir�specdon.The inspection
w�as perfamed based on my trair�ing and e�cperience in the pfop��nction ar�d maintenance of on site
s�awage dsposal systems.t am a [�'appe+�ved syabem ir�pector pursuar�t bo Sectiart 15.340 of
Tiqe 5(S14 CMR 76.l100). The system:
❑ P� ❑ Con�tionaily Passes Faiis
❑ Neet�Further Evalu�on by the Locai Approvi�g Aukhority
�� ?I '
Gx11� ���"��
t�s a�pr�tre oeea
Tl�e system inspector st�atl submit a cop�r of this inspectia�r'epoR to the Approving At�twritY(Board
af H�Ith�DEP)within 30 days of compteting this inspection. If the system is a st�ar+ed system ar
hes a design�ow of 10,006�d or greater,the ir�pector and the aystem owrwr shell subm�the
r�art to the a�propria�e re�or�ai o�ot tl�DEP. The origirr�stwuld be sent to the systam awner
and oopies sent tc the buyer, if appiic�te.and the approvirtg a�hority. '
�'*"Thls repori oniy ciesuibes condltions at tfw tlme of lnapectlon and undee tl�e oonditlats of use
at fhat time.Thls fnspectlon does not address how fhe aystiem will pertortn in the futw� under
the same or dM�ee+ent conditlon�af use.
18hs•8N8 TMaBOfAeWI IntpacianFaa[9uaufaos8e�w7��'P�$1�'PW 10f17